Altered postural regulation of foot skin oxygenation and blood flow in patients with type 2 diabetes mellitus.
ABSTRACT Although skin oxygenation is an important factor in the development and healing of foot ulcers, its regulation was not fully understood. We studied changes in foot skin oxygenation and blood flow during postural changes in patients with type 2 diabetes mellitus.
Skin oxygenation was measured using transcutaneous oxygen pressure (TcPO(2)) and skin blood flow by laser Doppler flowmetry in 40 patients with type 2 diabetes mellitus without evidence of peripheral arterial disease and 13 healthy control subjects.
TcPO(2) in the supine position was significantly lower in patients with type 2 diabetes mellitus compared with control, although skin blood flow was not different. In the sitting position, TcPO(2) significantly increased in control and diabetic patients. The postural change-related increase in TcPO(2) was significantly enhanced in diabetic patients. On the other hand, skin blood blow significantly decreased in the sitting position from the supine position in control subjects but remained stable in diabetic patients. Orthostatic drop in systolic blood pressure correlated negatively with TcPO(2) in the supine position while correlated positively with %change in TcPO(2) and blood flow by postural changes.
The present study demonstrated the dissociated regulation of skin oxygenation and blood flow in response to leg dependency. Impaired postural vasoconstriction was associated with altered regulation of skin oxygenation probably due to sympathetic vascular dysfunction in diabetic patients.
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ABSTRACT: Lower limb ischemia with poor wound healing is found in patients with diabetic foot disease and peripheral arterial occlusive disease (PAOD) and remains a major reason for lower limb amputa-tions. Specifically, more than 60% of nontraumatic lower limb amputations in the United States are per-formed in patients with diabetes. 1 In addition, elderly patients with diabetes have a higher prevalence of Background: Plastic and reconstructive surgeons are commonly faced with chronic ulcerations and consecutive wound infections of the feet as com-plications in patients with diabetes and/or peripheral arterial occlusive disease (PAOD). Microcirculatory changes seem to play an important role. However, the evaluation of functional changes in the soft tissue microcir-culation at the plantar foot using combined Laser-Doppler and Photospec-trometry System has not yet been performed in patients with DM or PAOD. Methods: A prospective, controlled cohort study was designed consisting of a total of 107 subjects allocated to 1 of 3 groups—group A: healthy sub-jects (57% males, 63.3 y); group B: patients with diabetes mellitus (DM) (53% males, 59.4 y); and group C: patients with PAOD (81% males, 66.1 y). Microcirculatory data were assessed using a combined Laser-Doppler and Photospectrometry System. Results: Global cutaneous oxygen saturation microcirculation at the plan-tar foot of healthy individuals was 8.4% higher than in patients with DM and 8.1% higher than in patients with PAOD (both P = 0.033). Patients with diabetes did not show significant differences in global cutaneous blood flow when compared with either healthy subjects or patients suffer-ing from PAOD. Conclusions: Functional microcirculation at the plantar foot differs be-tween healthy subjects and patients suffering from diabetes or PAOD of the same age. Patients with either diabetes or PAOD demonstrate deteriorated cutaneous oxygen saturation with equivalent blood perfusion at the plan-tar foot. More clinical studies have to be conducted to evaluate therapeu-tical methods that might ameliorate cutaneous oxygen saturation within diabetic foot disease and PAOD. (Plast Reconstr Surg Glob Open 2013;1:e48; doi:10.1097/GOX.0b013e3182a4b9cb; Published online 1 October 2013.) Plastic and Aesthetic Surgery, Hospital Essen Mitte, Essen, Germany; Department of Otolaryngol-ogy, Hannover Medical School, Hannover, Germany; and ||Sport Practice, Hanover, Germany. Received for publication February 18, 2013; accepted July 05, 2013. Drs. Kabbani and Rotter contributed equally to this work.Plastic and Reconstructive Surgery – Global Open (PRS GO). 10/2013;
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ABSTRACT: Abstract Introduction: During recent years, the role of microcirculation has received increasing attention especially for its potential pathogenic role in the development of diabetes complications, particularly diabetic foot syndrome. The aim of this study was to evaluate the differences in the skin microcirculatory reactivity on the upper and lower extremities (UE and LE, respectively) in the patient with type 2 diabetes mellitus (T2DM). We also evaluated the changes in the skin microcirculation independently of the individual test for peripheral diabetic neuropathy (DN) diagnosis (Semmes-Weinstein monofilaments, Bio-Thesiometer [Bio-Medical Instrument Co., Newbury, OH], and Neuropad(®) [TRIGOcare International GmbH, Wiehl, Germany]). Patients and Methods: Fifty-two patients with T2DM were enrolled. Miscrovascular reactivity was measured by laser Doppler iontophoresis, using 1% acetylcholine chloride (ACH) and 1% sodium nitroprusside. Results: Significant reduction of perfusion was found in LE compared with UE when using ACH. In patients with DN skin microvascular reactivity on LE and UE was reduced, compared with patients without DN. Impaired skin microvascular reactivity to ACH (dominant on LE) was demonstrate in all patients who were positive in at least one of the tests for the presence of DN. Conclusions: Reactivity of the skin microcirculation is worse on the foot than on the hand. This study confirmed a close relationship of DN and impaired skin microcirculation. It seems that autonomous neuropathy (assessed using the Neuropad) precedes the manifestation of somatosensory neuropathy.Diabetes Technology & Therapeutics 08/2013; · 2.21 Impact Factor
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ABSTRACT: Aims The assessment of transcutaneous oxygen pressure (TcPO2) may serve as a non-invasive and lower-cost alternative to nerve conduction studies (NCSs) for the diagnosis of diabetic peripheral neuropathy (DPN). The aim of this study was to determine whether the measurement of TcPO2 is useful for evaluating DPN. Methods We performed a cross-sectional study of 381 consecutive hospitalized diabetic patients classified by clinical examination and NCS as having DPN. Anthropometric and metabolic parameters were assessed. The TcPO2 examination was performed in both supine and sitting positions. Results Three hundred and one patients had DPN. The TcPO2 in both the supine and sitting positions was highest in the Non-DPN group and lower in the confirmed DPN group than the other three groups (p < 0.001). The Non-DPN group had the lowest sitting-supine position difference in TcPO2 among the groups (p < 0.001). The risk factors strongly associated with DPN included sitting-supine position difference in TcPO2 (OR =4.971, p < 0.001), diabetic retinopathy (DR) (odds ratio [OR] =3.794, p =0.002), and HbA1c (OR =1.534, p =0.033). The area under the curve (AUC) of the sitting-supine position difference in TcPO2 was 0.722 and revealed an optimal cutoff point for the identification of DPN (19.5 mmHg) that had a sensitivity of 0.611 and a specificity of 0.738 based on AUC analysis. Conclusions This large study of diabetic patients confirms that the sitting-supine position difference in TcPO2 is higher in DPN patients than control subjects, indicating that TcPO2 examination is a promising valuable diagnostic tool for DPN.Diabetes Research and Clinical Practice. 01/2014;